A Victorian coroner is calling for more research into the long-term effects of head knocks in sport, in a report detailing the extent of former AFL player Danny Frawley’s mental health decline in the years and days before the St Kilda great took his own life.
Handing down her findings into Frawley’s death on Tuesday, coroner Paresa Spanos confirmed a post-mortem analysis of the former Richmond coach’s brain found he had low-stage chronic traumatic encephalopathy, a brain disease linked to repeated blows to the head.
It comes a week after Guardian Australia revealed the AFL is considering a proposal for the establishment of a multimillion-dollar trust to assist past, present and future players suffering from the long-term effects of concussion that could, if accepted, represent a turning point in the way collision-based sports all over the world tackle head trauma.
Spanos said researching the impacts of contact sports on the brains of AFL players could save lives as there is currently insufficient knowledge about the extent to which CTE produces neurological dysfunction, in part because of a lack of research in Australia and internationally.
“Mr Frawley retired from professional football prior to the discovery of CTE and the implementation of current AFL policies and procedures aimed at minimising the consequences of concussions and repeated sub-concussive injuries,” Spanos wrote.
“There is a strong consensus that more research into CTE is needed to improve understanding of the condition, its diagnosis and the prevention or at least minimisation of the impacts of CTE in AFL players.”
CTE, which can only be diagnosed after death, is associated with mood and behavioural changes along with cognitive and memory impairment.
Frawley died in a car crash in September 2019, aged 56. The coroner said his mental state began deteriorating in the months before his death and appeared to coincide with ceasing his medication and several “psychosocial stressors”.
Spanos found that “at its highest, CTE is a potential contributor” to Frawley’s depression in the years preceding his death.
“Like many players, Mr Frawley began his football career in his formative years, and likely experienced head trauma while his brain was still developing,” she said. “As such, it is difficult to evaluate the contribution of CTE to personality, behaviours, any cognitive deficits, or emotion over a lifetime.
“As CTE can only be diagnosed post-mortem, it is impossible to establish at what point CTE began and whether this coincided with any changes in mood or behaviour.”
The report states Frawley had been seeing a psychiatrist since 2014 and presented with a history of a “depressive breakdown”, noting with work with the AFL Coaches Association was a contributing factor.
“He had a significant constellation of depressive symptoms including significant insomnia, depressive ruminations, relative anhedonia, self-reproachment, a motivation, difficulty functioning and episodic passive suicidality,” it states.
“He had also engaged in poor decision making and conduct that caused conflict in his marriage.”
Frawley’s psychiatrist described him as a “particularly needy” patient due to his “fragile emotional state” and required frequent sessions and review. Frawley’s wife, Anita, felt it took her husband at least a year to recover “but he was never the same”.
“To his family, Mr Frawley would lie in bed all week and be extremely needy, but he would be able to put on a brave ‘public face’ and give the appearance of normal functioning,” the report states.
Anita said he never revealed the extent of his private suffering to friends or the public, even while acting as a public advocate for men’s mental health. In late 2018, the psychiatrist noted Frawley had decreased his dose of antidepressants without consultation and wanted to cease them altogether.
In January 2019, the report states Frawley’s demeanour had improved significantly, but that he ceased his medication, telling his wife he had done so with the permission of his doctor. From then, his media presence decreased considerably because it appeared to his wife to “to bruise his ego”.
One month before his death Frawley returned to his psychiatrist, who reported Frawley had disengaged with treatment because he had felt “bulletproof”.
His medication was recommenced. He last saw his psychiatrist on 6 September, 2019 – three days before his death.
The coroner said the weight of the available evidence supported a finding that Frawley intentionally taken his own life, however could not ascertain to what degree, if any, CTE had contributed to his mental health difficulties and/or death.
“In the period immediately preceding his death, Mr Frawley was experiencing a number of personal and professional stressors, and a significant deterioration in his mental state, with an exacerbation of the anxiety and depression he had been suffering for some five years,” Spanos found.
“At its highest, CTE is a potential contributor to the depression that Mr Frawley suffered for some years preceding his death. The available evidence does not enable me to determine which particular suicide stressor caused or contributed to Mr Frawley’s death.”
She found nothing to support any failures in Frawley’s clinical management.
“Like many professional football players, Mr Frawley began his football career in his formative years and likely experienced head trauma before his personality was well established,” Spanos wrote. “This coupled with the inability to diagnose CTE before death, confounds evaluation of the contribution of CTE to personality, behaviours, any cognitive deficits, or lability of mood.”
The coroner recommended the AFL and Australian Football League Players’ Association actively encourage players and, their legal representatives after their death, to donate their brains to the Australian Sports Brain Bank in order to make a meaningful contribution to research into CTE.
Changes to coronial processes and practices to better identify CTE were also recommended.
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